Ankyloblepharon filiforme adnatum (AFA) associated with trisomy 18

Ankyloblepharon filiforme adnatum (AFA) is a rare congenital anomaly which is characterized by single or multiple strands joining the upper and lower lids. Its etiology is unknown. A girl with a gestational age of 38 weeks is presented. It was interesting to find an association of AFA with hypoplasia of hair, eyelashes, eyebrows and nails and a karyotype of trisomy 18 in this case.     

Effects of tibolone on endogenous nitric oxide (nitrite/nitrate levels) in postmenopausal women

OBJECTIVE: To observe the effects of hormone replacement therapy with 2.5 mg/day tibolone for 6 months upon plasma nitrite/nitrate (end products of nitric oxide metabolism) in postmenopausal women. PATIENTS AND METHODS: The study involved 24 healthy postmenopausal women treated with tibolone (2.5 mg/day for 6 months) and 20 postmenopausal women who received placebo. Plasma nitrite/nitrate levels were measured with the Griess reaction. Statistical significance was analyzed by the Mann-Whitney U test and Pearson correlation analysis. RESULTS: The mean baseline concentrations of nitrite/nitrate were similar in both treated and placebo groups. Tibolone treatment decreased plasma nitrite/nitrate levels. CONCLUSIONS: We suggest that because of its androgenic and progestogenic actions, tibolone diminishes nitrite/nitrate levels. Also our data provide evidence for the existence of increased (1/3 of subjects, n = 8) and reduced (2/3 of subjects, n = 16) nitrite/nitrate levels in response to tibolone treatment. Clearly, further studies are necessary to establish a risk/benefit ratio for tibolone in view of its effects on nitric oxide metabolism.     

Retroperitoneal benign schwannoma: report of three cases and analysis of clinico-radiologic findings

Retroperitoneal schwannoma is a rare tumor that originates in the neural sheath and accounts for only a small percentage of retroperitoneal tumors. Presentation is typically varied and non-specific ranging from abdominal pain, abdominal mass or an incidental finding and the diagnosis is quite often fortuitous being confirmed by anatomopathological study afterwards. We report 3 cases of benign retroperitoneal pelvic schwannoma with varied presentations. Main symptoms were abdominal and pelvic pain whereas a patient with left parailiac mass had urinary incontinence and left lower extremity pain. Surgical exploration and complete excision of tumors were successful. The histological diagnosis of the tumors was reported as benign schwannoma. All patients are doing well and had no symptoms of motor or sensory disturbances after surgery with a mean follow up of 18 mounts.     

Outcome of nephron-sparing surgery: elective versus imperative indications

INTRODUCTION: The increase in the detection of renal tumors incidentally in earlier stages has enhanced the enthusiasm for nephron-sparing surgery (NSS). PATIENTS AND METHODS: We performed NSS in 76 patients (53 male, 23 female) with a mean age 52.3 between December 1988 and September 2001. Patients were sub-classified into 2 groups as elective or imperative indication group. They were compared regarding surgical technique, time of surgery, pathological analysis, complications, and disease free status. RESULTS: Elective indication group (group I) with a normal contralateral kidney consisted of 50 patients, whereas there were 26 patients in the imperative indication group (group II). Tumors were incidentally detected in 63%; 74% in group I and 42% in group II. Although the mean diameter of the tumor was slightly higher in group II (39.1 vs. 36.3 mm), this difference did not reach statistical significance (p > 0.05). The partial nephrectomy was performed more frequently compared to enucleation in group I (90 vs. 69%, p = 0.050). However, the mean operation time as well as the mean clamping time did not differ significantly between the two groups (p > 0.05). In the histological evaluation tumors were benign in 16 (21%) and malignant in 60 patients. All of the patients but one with renal cell carcinoma had stage T1-T2 disease. Major complications were observed in 14 (18%) and 12 were from group II. Complication rate was significantly higher in group II (p = 0.000). Of 60 patients with renal cell carcinoma, 2 died of unrelated causes. One patient died with multiple visceral metastases. One patient was lost to follow-up. In the remaining 56 patients with a mean follow-up of 37.1 months (1-152), local recurrence or distant metastases were not detected. Serum creatinine levels have remained almost the same compared to preoperative levels (1.2 +/- 0.6 vs. 1.5 +/- 0.9). Overall and cancer-specific survivals were 100 and 100% in group I, 85 and 95% in group II, and 94 and 98% for the entire patient population, respectively. CONCLUSION: NSS is an effective and reliable treatment in low stage renal tumors. It prevents unnecessary nephrectomy in benign lesions that could not be diagnosed preoperatively. However, the patients who underwent NSS with elective indication outcome with better results, compared to those with imperative indication.     

Gastrocystoplasty in pigs and effect of selective antral vagotomy on acid secretion of the reconstructed bladder

INTRODUCTION: The aim of this study was to investigate the outcome of gastrocystoplasty and the effects of selective antral vagotomy (SAV) on the postprandial gastrin secretion from the antrum as well as on the acid secretion from the augmented bladder. MATERIALS AND METHODS: In this study on 12 male pigs, we applied subtotal cystectomy plus gastric augmentation plus SAV to the study group and the same procedure without SAV to the control group. The animals were followed up for 3 months with respect to feeding, weight, and urine output. The urine pH levels and the gastrin levels of the pigs in the two groups were then followed up and compared. RESULTS: The use of gastric segments in bladder reconstruction was found to be appropriate in terms of both gastric function and urinary system function. Nevertheless, regarding the effect of SAV, the differences between either the urinary pH levels or the gastrin levels of the pigs in the two groups were statistically significant. CONCLUSIONS: Although gastric segments in the bladder reconstruction were found to be appropriate in terms of both gastric function and urinary system function, SAV did not prevent postprandial gastrin secretion and the resulting increase of the urine acidity.     

The use of transversely tubularized bowel segment for segmental ureteral replacement

The aim of the present study was to evaluate the results of the use of a new technique, i.e. transversely tubularized bowel segment (TTBS) for segmental ureteral replacement in pigs. Eight pigs had segmental left ureteral replacement with the TTBS technique, via midline incision in 5 and flank incision in 3. The right ureters were left untouched and used as controls. The pigs were evaluated by excretory urography approximately 3 months after surgery and then sacrificed thereafter, harvesting the kidneys, ureters, and the bladders en bloc for macroscopic and histologic examination. Three pigs died in the early postoperative period. The remaining 5 pigs were followed for 82-112 days. Postoperative intravenous urograms revealed moderate ureterohydronephrosis in 2, mild ureteral dilation in 1, and normal upper tracts in 2. The 2 pigs with moderate ureterohydronephrosis had had midline incisions, and examination after having sacrificed these pigs revealed many intestinal adhesions to the anastomotic region. Easy catheterization of each left ureter through ileal ureteral segment and histologic examination thereafter demonstrated that all ileal ureteral segments including anastomotic sites were patent. Adjacent to the junctional area, metaplastic transitional epithelium covered atrophic villi and in some regions crypts as well. Ureteral replacement by the TTBS technique seems to be a safe and effective surgical treatment option in segmental ureteral defects in short term. However, long-term follow-up studies are needed.     

The effects of gingko biloba extract (EGb 761) on experimental acute pancreatitis

BACKGROUND AND OBJECTIVE: Acute pancreatitis is an important and fatal disease with high mortality and morbidity. Although the pathogenesis of acute pancreatitis is poorly understood, there are many studies that suggest the role for oxygen free radicals (OFRs) in the development of pancreatitis and its complications and show beneficial effects of scavenger treatment. In the present study, we aimed to investigate whether Egb761, the standardized extract of gingko biloba, restrains the generation of OFRs and ameliorates the histopathologic findings of acute pancreatitis. MATERIALS AND METHODS: Sixty male Sprague Dawley rats were randomly assigned to one of the following experimental groups. In early and late pancreatitis and treatment groups, acute pancreatitis was induced by retrograde infusion of 3% sodium taurocholate. In treatment groups, 100 mg/kg Egb 761 was given intraperitoneally (IP) 24 h and immediately before induction of pancreatitis. Sham-operated rats received isotonic saline instead of sodium taurocholate. After observation times of 3.5 and 12 h, the pancreas was removed for light microscopy and determination of malondialdehyde (MDA) levels as a marker for OFRs-induced lipid peroxidation. Serum samples also were obtained for amylase and lipase levels. RESULTS: There was no significant difference in control and sham-operated groups in terms of histopathologic findings and serum enzyme levels. The tissue concentrations of MDA and serum enzyme levels were significantly elevated in early and late treatment groups as compared with the control group. The treatment with Egb 761 caused significant decrease in serum amylase and lipase levels and histopathologic scores as compared with early and late pancreatitis groups. CONCLUSIONS: Prophylactic application of Egb761 exerts highly beneficial influence on the course of acute pancreatitis, and this seems to be related to the oxygen radical scavenger effect of Egb761.     

Effects of shock wave lithotripsy on plasma and urinary levels of nitrite and adrenomedullin

Purpose: In this prospective clinical study, we aimed to determine whether shockwave lithotripsy (SWL) has any specific effect on plasma as well as urinary nitrite, a stabile metabolite of nitric oxide (NO) and adrenomedullin (AM) concentrations, and to investigate whether these variables can be used as a marker for detecting shockwave-induced impairment of renal tubular and glomerular cells. Material and Methods: A total of 20 patients with renal pelvic or caliceal stones 2 cm undergoing anesthesia-free SWL without auxiliary measures and a control group of ten patients without any urological symptoms were included in this study. The plasma and urinary concentrations of nitrite and AM were measured before, 24 h, and 7 days after SWL. Nitrite levels were measured by Griess reaction. Reverse-phase high-performance liquid chromatography (HPLC) was used to determine AM levels. Results: Application of high-energy shock waves (HESW) in our study caused a statistically significant increase in plasma levels of both NO and AM, which reflected an organized response of the kidney to this type of trauma in an attempt to maintain normal renal hemodynamics. Mean plasma nitrite concentration before SWL application was 29.9±7.6 mol/l and this value was found to be 39.02±8.45 mol/l at 24-h follow-up. Comparative evaluation of the plasma concentrations of AM revealed a significant increase at the 24-h examination: 20.51±3.0 pmol/ml and 32.54±4.3 pmol/l, respectively. On the other hand, comparative evaluation of urinary levels of both nitrite and AM levels before as well as 24 h after SWL application revealed a statistically significant increase related to markers. Conclusion: This first clinical study on plasma-urinary nitrite and AM levels in patients undergoing the SWL procedure indicated that plasma and urine levels of both peptides were increased. Our findings in turn suggested that SWL application to kidneycan stimulate the NO-cGMP signalling pathway to increase NO production in the kidney. Our findings also indicated that the increased levels of NO and AM secretion during renal parenchymal ischemia may be protective enough for renal pathological alterations resulting from SWL-induced renal trauma. We suggest that this increase may be a compensatory response to SWL induced injury.     

The relation between tooth loss and bone mass in postmenopausal osteoporotic women in Turkey: a multicenter study

 The purpose of this study was to investigate the associations of tooth loss with skeletal bone mass, years since menopause, educational level, current smoking status, dietary calcium intake, and number of pregnancies in postmenopausal osteoporotic women in Turkey. The study population consisted of 1171 postmenopausal women aged 40–86 years (mean age, 61.19 ± 7.28 years). A detailed history was obtained from all women, including relevant lifestyle parameters, risk factors, and measurements of weight and height. Women were separated into three groups according to the number of teeth remaining as group 1 (edentulous, 457 women), group 2 (10 or fewer teeth, 232 women), and group 3 (more than 10 teeth remaining, 482 women). There was no significant difference among the three groups in mean age and menopausal age (P < 0.05). Body mass index of group 1 was significantly higher than that of group 2 (P < 0.01). Educational level was significantly different between three groups: groups 1 and 2 (P < 0.001), groups 1 and 3 (P < 0.0001), and groups 2 and 3 (P < 0.001). Educational level was lowest in group 1 and highest in group 3. Despite a low ratio of cigarette smoking in general, a smoking habit was most prevalent in group 3 and least in group 2. The ratio of women receiving adequate calcium was significantly lower in group 1 than in other groups (P < 0.001); mean calcium intake was similar in all groups. The number of pregnancies was significantly higher in group 1 than in other groups (P < 0.001). Lumbar bone mineral density (BMD) of group 1 was significantly lower than that of groups 2 and 3 (P < 0.001). Although no significant difference was found between groups 1 and 3, femoral neck BMD of group 2 was less than in others, and differences between groups 1 and 2 and between groups 2 and 3 (P < 0.001) were significant. Lumbar bone mineral content (BMC) of group 1 was significantly lower than that of groups 2 and 3 (P < 0.001), and lumbar BMC in group 2 was significantly higher than in group 3 (P < 0.05). Femoral neck BMC in group 1 was significantly higher than in groups 2 and 3 (P < 0.001). In conclusion, lumbar BMD and BMC in the edentulous group were significantly lower, whereas femoral neck BMD and BMC were significantly higher in edentulous group compared with the others. Our findings indicated that improvement in lifestyle factors and nutritional strategies for the treatment and prevention of osteoporosis may have additional benefit in reducing tooth loss. Received: February 18, 2002 / Accepted: June 21, 2002 Offprint requests to: A. Gur